FND Action Respond To Failures In FND Understanding

We remain deeply concerned about the 2024 publication, “The DSM-5 Classification of Functional Neurological Symptom Disorders: Critical Appraisal and Recommendations” (Scamvougeras et al, Canadian Journal of Psychiatry).

“Functional Neurological Disorders: Challenging the Mainstream Agnostic Causative Position”

https://journals.sagepub.com/doi/10.1177/07067437241245957

Although this paper was published last year, we recently revisited it after it was shared again publicly. We had hoped that by now, formal rebuttals or clarifications would have been published by FND specialists. Sadly, this has not happened.

As a patient-led charity, it is our responsibility to speak up. We must highlight where misinformation and outdated attitudes persist – not to attack individuals, but to protect those living with FND today, and to shape a better future for care, research, and clinical education.

Our major concerns include:

Lack of understanding of modern FND diagnostics
The authors misrepresent how FND is diagnosed today, ignoring internationally recognised, positive diagnostic signs (e.g. Hoover’s sign, tremor entrainment). [Espay et al., 2018; Stone et al., 2022.]

Erosion of patient trust
By suggesting that an FND diagnosis should default to a psychiatric label if no “organic disease” is found – despite FND having clear clinical criteria – the article promotes medical gaslighting and delays appropriate treatment.

Stigmatising, dismissive tone
The paper reinforces harmful stereotypes about FND patients being “difficult” or “resistant” rather than acknowledging the structural failures patients face. This language does real-world harm.

Ignoring misdiagnosis risk and harm
The authors fail to acknowledge growing evidence that misdiagnosis and diagnostic overshadowing cause serious iatrogenic harm. [Stone et al., 2021; McLoughlin et al., 2025 – post publication date.]

Absence of modern research references
The authors appear to be presenting a simplistic one-sided and outdated “Freudian” interpretation of FND, for which there has never been any definitive scientific evidence – meaning that it is no more than an unproven theory. To add to this, there is also the fact that Freud falsified results with regards to many of his patients, including in his work “Studies on Hysteria” – the book in which his theory is presented.

The article omits landmark advances in FND understanding, including neuroimaging studies showing brain network dysfunction [Voon et al., 2016; Perez et al., 2021], and the move towards integrated biopsychosocial care models. Furthermore, the authors ignore recent scientific evidence that clearly demonstrates there is a significant proportion of FND patients who do not have any psychological trauma. [Ludwig et al., 2018; Paredes-Echeverri et al., 2023]

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Addressing Misconceptions About FND Action and Patient Support Groups:

It is deeply disappointing that the authors of this paper have felt the need to misrepresent FND Action and other patient support groups. The article inaccurately portrays us as dismissing psychological factors altogether. Let’s be clear: we do not reject the role of psychological factors in FND. However, we reject the reductionist approach that frames FND solely as a psychiatric issue, and we certainly do not support the harmful narrative that FND is merely a “reaction to stress”, “psychological disorder”, or “psychosomatic”.

By quoting us in the context of these mischaracterisations, the authors imply that patient groups like ours are spreading misinformation and hindering progress. This is not only misleading but actively undermines the work we do in advocating for holistic, evidence-based care that respects the lived experiences of those with FND.

We advocate for an integrated approach to FND – one that considers the biological, neurological, and psychological aspects. We do not subscribe to the harmful, oversimplified narratives that suggest FND can be neatly categorised as solely psychiatric. FND is a complex, multifactorial condition that requires comprehensive, patient-centred care.

By incorrectly quoting us, the authors perpetuate a damaging myth about patient support organisations, ignoring the positive contributions that we have made in educating the public, advocating for better care, and ensuring that patients are treated with dignity and respect.

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Final thoughts:

The statement ending the article – that patients should be told “no disease is found” and steered immediately toward psychiatric diagnosis – is outdated, harmful, and ignores everything modern FND research teaches us about brain function and symptoms.

We recognise that many clinicians working in FND today are dedicated to compassionate, evidence-based care. However, silence in the face of public misinformation hurts all of us – and most of all, those living with FND.

The kind of outdated attitudes presented in this paper continue to cause significant harm to patients. Recent Studies from both FND Action and FND Hope have demonstrated that between 80-96% of patients have experienced a stimatising and negative interaction with clinicians.

As a community, we must stand together to challenge harmful narratives, promote scientific integrity, and demand better for those living with FND.